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General NPI Number Information
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NPI Number | 1780655985
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Entity Type | Organization
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Legal Business Name | LOCATEL STORES OPERATIONS LLC
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 1715 E HALLANDALE BEACH BLVD
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4621
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Country | US
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Telephone | 954-416-1200
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Fax | 954-416-1216
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Provider Business Mailing Address
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Address Line | 1715 E HALLANDALE BEACH BLVD
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4621
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Country | US
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Telephone | 954-416-1200
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Fax | 954-416-1216
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Authorized Official
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Title or Position | CEO
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Name | MR. MAURICE RUAH
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Credential |
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Telephone | 954-416-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | PH20154
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License Number State | FL
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